When antidepressants have failed, researchers say, an option called transcranial magnetic stimulation is growing in popularity as an effective treatment for depression.

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MONDAY, May 14, 2012 — Almost one-tenth of Americans report they are depressed at least occasionally, and while talk therapy and antidepressants help to treat many of these cases, they don't always work for some people with serious depression.

Now, new research released at the annual meeting of the American Psychiatric Association last week adds to the growing support for a painless, noninvasive therapy that uses magnets to help to relieve depression by stimulating certain areas of the brain.

In the new study from
a collaborative network of clinics around the US, 58 percent of the 307
patients with clinical depression who were treated with the technique, called
transcranial magnetic stimulation (TMS), were helped by the therapy.
About a third of the patients went into remission, according to the
researchers.

"While medications have made a tremendous change for people over the past several decades, there are many people for whom medications don’t work as well as they should," says Ian Cook, MD, director of the UCLA Depression Research Program and a member of the study team. "Having this as an option really expands the number of people who expect to recover from depression."

The device that delivers TMS therapy, the only such device approved for use in the United States by the Food and Drug Administration, is made by Neuronetics of Malvern, Pa., and is called NeuroStar. It was approved by the FDA in 2008, and specifically recommended for patients whose depression isn't treatable with antidepressants. Since then, use of TMS has dramatically increased. About 5,000 patients have been been treated with it at about 400 sites nationwide, according to the device maker, as quoted in The Boston Globe.

How Transcranial Magnetic Stimulation Works

TMS uses a magnetic field to produce a low electric current to stimulate the brain. While the patient sits in a reclining chair without need of anesthetic, the treating doctor or technician aims the magnet toward the front of the head — the prefrontal cortex — as the device beams about 3,000 electrical pulses in a treatment session. Patients with depression display less activity in that brain region, previous studies have shown. Doctors say the TMS current probably excites brain cells and stimulates them to fire. The procedure takes about 40 minutes.

"The odd thing is that the pressure was coming from the inside of your head, not the outside," said Ruth Schwer, a patient who used the treatment, in an Indianapolis Star article. She described the sensation as feeling like a woodpecker tapping against her skull. Over time, she got used to it, she told the Star. After her third week on the treatment, Schwer felt it was working. "I realized I had the freedom to direct my attention to where I wanted it to go," she told the paper. "Having the option to experience happiness and joy, I felt like something had definitely changed for me."

An Alternative to Electroshock?

TMS may sound a bit like electroshock therapy, which triggers brain seizures to increase activity in the left frontal region. But the current used in TMS produces clinical benefits without seizures. It is much milder than that of electroshock treatment, which requires general anesthesia and has been linked to memory and other cognitive losses.

Until now, electroshock therapy has been the only real option for patients with severe depression for whom talk therapy or medications had not worked.

"Electroconvulsive therapy has been around since 1930s and remains the proverbial large gun to use when nothing else has helped," Dr. Cook says. "That is still going to be the case for a long time to come, but now TMS has become something else to try earlier in the treatment option algorithm."

About half of patients treated with TMS have shown improvement, a rate that's lower than for patients treated with electroconvulsive therapy, which has an 86 percent success rate for severe depression. But because magnetic therapy is non-invasive and involves no medication, it could be an attractive treatment alternative to electroconvulsive therapy for some people. Researchers have recommended more study of possible side effects of TMS, which may include alterations to immune system or neurotransmitter activity.

TMS treatment is typically given five times a week for four to six weeks and can be given in conjunction with antidepressant treatment. Electroconvulsive therapy is typically given two or three times a week for 6 to 12 treatments, according to DoctorOz.com.

One study that looked at the long-term effectiveness of TMS found that benefits lasted at least six months after treatment when patients also stayed on one antidepressant medication. "There are people who have speculated that TMS may change the brain's sensitivity to medications, among its many effects" Cook says. "Things that had not been effective before seem to have a new lease on helping depression after TMS." Longer-term benefits of TMS alone have not been studied, Cook notes.

The Future for Magnetic Pulse Therapy for Depression

A Neuronetics spokesman said that scientists are currently studying whether TMS might be a safer approach to treating pregnant women suffering from depression to prevent antidepressants from entering the the baby's bloodstream. TMS is also being tested in clinical trials for conditions including epilepsy, tinnitus, pain, Parkinson's disease, Alzheimer's disease, schizophrenia, and stroke, according to U.S. News and World Report.

"There's burgeoning research with [magnetic pulse therapy] because it's very well tolerated," Rizwan Kahn, a board certified psychiatrist at St. Francis Hospital in Columbia, Ga., told the Columbus-Ledger Inquirer. "If you have a treatment that's well-tolerated, that can be a big plus. I think there is a very bright future with this modality."

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